Researchers investigate whether NHS rules could miss childhood retinopathy

A new study has cast doubt on the screening process looking for diabetic retinopathy in young people with type 1 diabetes.
Currently, the NHS say that screening for diabetic retinopathy in children with diabetes should start at the age of 12.
This is because cases of children with sight-threatening diabetic retinopathy below the ages of 12 are assumed to be extremely rare.
Researchers from Birmingham sought to see whether the current guidelines were sound, whether they could be putting people at risk, and whether an update was in order.
They carried out a retrospective analysis of 143 patients aged 12 and under who were registered with the Birmingham, Solihull and Black Country Diabetic Eye Screening Programme.
55 per cent of participants were boys, and 98 per cent had type 1 diabetes. The average age was 10.7 years old, ranging from 7 years and four months to 12 years and 11 months. Screening doesn’t start until 12 years of age, under current guidelines, and so the reason data was included for children younger than 12 is because those participants were referred from local hospitals for special screening.
Unfortunately, this factor runs the risk of selection bias affecting the results. Furthermore, ethnicity was not recorded accurately or consistently enough for the researchers to analyse the data based on heritage.
Optometrists carried out eye screenings of all the participants in the study, including imaging of the retina, looking for markers of diabetic retinopathy. They were graded in line with NHS Diabetes Eye Screening Programme guidelines.
Twelve patients were found to have retinopathy (seven were younger than 12, five were 12 or over). None of these participants were found to have any vision impairment from their retinopathy, but background retinopathy was present.
Rather than age, the researchers found that it was the duration of diabetes that seemed to affect whether a child would test positive for diabetic retinopathy. Only patients that had had diabetes for six years or more had retinopathy.
This seems to go against what the current NHS guidelines are – to test for sight related problems from the age of 12 onward.
However, the study found no cases in which vision was threatened by diabetic retinopathy. This supports the current guidelines.
The researchers realised that it depended on what the screening set out to achieve. They wrote: “Based on the current mission statement of the Diabetic Eye Screening Programme to identify sight-threatening diabetic retinopathy, 12 years of age is confirmed as the right age to start screening, but if it is important to diabetic management to identify first development of diabetic retinopathy, then screening should begin after 6 years of diabetes diagnosis.”